DOAC underdosing in almost one in four inpatients

High rates of inappropriate inpatient DOAC dosing in AF have been  identified in a study covering six South Australian public hospitals.

A retrospective analysis of hospital records for 1882 inpatients from December 2013 to November 2019  found that 544 (29 %) were inappropriately dosed.

Underdosing was the most common form of inappropriate dosing with rates of 23% (n = 295) for apixaban, 7.1 % (n = 7) for dabigatran and 25.1 % (n = 124) for rivaroxaban.

Risk factors for underdosing included older age , frailty and polypharmacy, according to study investigators from the Royal Adelaide Hospital, writing in the Journal of Thrombosis and Thrombolysis.

Physicians urged to avoid stigmatising language in medical records

When writing in a patient’s medical record, physicians should be conscious of the use of language that reinforces negative and stigmatising attitudes toward patients that may influence the decisions of other clinicians subsequently caring for that patient, according to the authors of a US study.

An analysis of 600 medical records written by 138 physicians at a major hospital identified five types of negative and judgmental language used to describe patient encounters that encompassed racial and class stereotyping, personal disapproval of their actions, questioning a patient’s credibility and portraying them as a difficult or non-compliant. The stigmatising attitudes found in medical notes also included the use of authoritative and paternalistic language by physicians in which they recorded themselves as ‘instructing’ patients, according to researchers from Johns Hopkins University.

In their article, published in JAMA Network Open, they offered six examples of how physicians could use positive and collaborative language in medical records including compliments, approval of positive behaviours and noting of humanising personal details, in addition to acknowledgement of the physician’s own negative attitude and explaining non-adherence in a non-judgmental way.

“Just as we have developed a greater understanding about microaggressions and micro-inequities, this study’s findings suggest that we must raise consciousness about how we write and read medical records,” they said.

“Language has a powerful role in influencing subsequent clinician attitudes and behaviour. Attention to this language could have a large influence on the promotion of respect and reduction of disparities for disadvantaged groups.”

Oral selinexor to be further investigated in RR DLBCL

Patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) show a consistent median overall survival (OS) of more than nine months with oral selinexor treatment across all patient subgroups, a new analysis of the SADAL trial shows

The survival outcomes are promising for a population in which survival is expected to be less than six months with current standard of care treatment, according to a report by Australian and international clinicians in the  Journal of Hematology & Oncology

The increased median OS observed in patients responding to selinexor was consistent across subgroups regardless of age, prior ASCT therapy, or refractory status, they said.

The SADAL study evaluated single-agent oral selinexor in patients with RR DLBCL and showed an overall response rate (ORR) of 29.1% with median duration of response (DOR) of 9.3 months

Randomised studies of selinexor in combination with a variety of other anti-DLBCL agents are planned, the study investigators said.